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An integrated malaria control strategy including home based malaria management (HMM) and seasonal malaria chemoprophylaxis (SMC) delivered by community health workers in Senegal
Malaria control strategies include HMM and SMC. Limited information is available on impact of combining antimalarial interventions. The present study aimed at assessing the feasibility and effectiveness of introducing an integrated malaria control strategy, including HMM and SMC delivered by community health workers (CHWs).
A cluster-randomised trial was carried out during 2 transmission seasons (2010-2011) in 8 villages located in the South-eastern part of Senegal. Intervention communities received HMM+SMC while control communities received HMM. Primary end point was: incidence of malaria attack during follow up. Secondary end points included: (i) malaria diagnostic accuracy (ii) access to ACT treatment (iii) SMC coverage (iv) safety and drug tolerability.
Among the 1000 enrolled children, malaria RDT was performed for 190 febrile children and 24% were RDT positive. The adjusted incidence rate ratio of malaria attacks was 0.149, indicating a protective effect of HMM+SMC at 85.1%, (95%CI[39.9%-96.3%], p=0.01). RDT sensitivity and specificity respectively represented 89.2%(95%CI:70–100) and 86.2% (95%CI:70.2–100); 96.4% of RDT confirmed malaria attack received AL. SMC coverage was 97.3% (95%CI:91.3–100) in 2010, and 94.1% (95%CI [89.3–99.2] in 2011. No serious adverse event was noted.
It is feasible to deliver SMC alongside an effective HMM intervention, while achieving high coverage and effectiveness of both SMC and HMM.